Monkeypox and kids: What to know about the virus spreading, vaccines and more

There have been 51 confirmed cases of monkeypox in Connecticut, as of Friday, according to the CDC. There has been no confirmed case among patients younger than 18 in this state, but health officials nationwide are preparing for the virus to spread among younger patients. There have been five known cases of monkeypox in children in the United States, according to media reports: Two in Indiana, one in California and one in Maine. A fourth child was not a U.S. resident, according to the CDC. That’s five cases, out of a total of 11,177 total confirmed monkeypox cases in the United States. The U.S. Food and Drug Administration, however, released guidance last week that allows children to be vaccinated against the virus. With school starting soon in Connecticut, Hearst Connecticut Media Group turned to Paulo Verardi, a UConn virologist and specialist in pox viruses, including smallpox and monkeypox, for answers about the risk to children. Here are his answers: Are children vulnerable to monkeypox? Answer: “Anyone can get infected with the monkeypox virus and develop clinical monkeypox. Children, the elderly, and those that are immunosuppressed or immunocompromised are at the highest risk of developing more severe disease. “So far during this outbreak, cases in children have been rare, likely because the virus started its spread in specific populations such as men who have sex with men.” Are children specifically at risk? A: “Anyone is at risk of contracting monkeypox and spreading it to other people, typically by direct, close contact, such as skin to skin contact. That includes touching monkeypox lesions that sometimes can be hard to notice, or touching and using objects such as toys, clothes, and bedding of someone that is infected. “In this context, it is important to point out that the virus can stay in the environment without losing infectivity for quite some time. Children are very active, social, and tactile, so spread in settings like schools and day care facilities is something we need to consider, particularly if the outbreak continues to evolve and infections become more widespread in diverse populations.” Does the disease traditionally present differently in younger people? Is the symptomology different? A: “In general, symptoms are similar in adults and children, although for this outbreak with this specific strain of the virus, our clinical experience in children is limited because we have had only a few cases so far. “Rash or skin lesions are typical, and fever and swollen lymph nodes (lymphadenopathy) are also common symptoms. However, children may be at higher risk of more severe disease and complications from monkeypox, particularly if they are very young, have skin conditions like eczema, or are immunocompromised.” The Jynneos vaccine is not approved for people under 18, but the FDA is granting case-by-case approval for children. Is that a good strategy? A: “The Jynneos vaccine is based on a non-replicating virus called vaccinia virus, and this replication-defective virus has shown to be safe in people with immunodeficiencies and eczema, including children. However, the Jynneos vaccine is only approved for people 18 and older. “Fortunately, the CDC allows vaccination of children after exposure to monkeypox (post-exposure prophylaxis) under an expanded access investigational new drug protocol. This strategy is appropriate due to the current small number of infections in children and the fact that we are facing a shortage of the vaccine.” Are there treatments available? A: “Investigational treatments are available for children such as tecovirimat (an antiviral) and vaccinia immune globulin (pool of antibodies that fight the virus).” Should there be wider vaccination if kids are at risk? Does the vaccine present problems for younger patients? A: “We should have been better prepared in the first place when it comes to availability of vaccines, and we need to be ready for the possibility of needing to vaccinate our kids more widely and not just after known or potential exposure. Therefore, we need to work on the full approval of Jynneos for those younger than 18.”

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